As reported by the Danbury News-Times, August 24, 2005.

Heart-pounding Heroin

Doctors Warn About Steroid-laced Version of Drug in State

By Robert Miller

There is never a good reason to try heroin. Now, there's a new, distressing reason not to use it — the street drug may be mixed with a veterinary drug that can nearly kill you.

The federal Centers for Disease Control and Prevention says Connecticut is one of a handful of states where people have become severely ill after using heroin laced with clenbuterol, a steroid used to treat horses that is not approved for human use in the United States. The drug can overtax the human heart.

Eight of the cases were reported in the Bridgeport area in April — five from snorting the drug, three from injecting it.

"It's a first," said Dr. Martin Belson, a medical toxicologist with the CDC. "It's hard to get a first in the business, but this is the first time we've seen clenbuterol."

"I have to say, this doesn't really make any sense," said Dr. Kelly Johnson-Arbor, a medical toxicologist with the University of Connecticut Health Center's Poison Control Center in Farmington, who helped analyze urine samples from four of the Connecticut drug users. "We've been talking to people in New York and New Jersey, and they can't figure it out, either."

The CDC reported the tainted heroin in the Aug. 19 edition of one of its publications, Morbidity and Mortality Weekly Report. The article said it found 26 people on the East Coast who became severely ill after using tainted heroin.

The first reports showed up in New Jersey in late January and early February. In February, there were similar cases in New York, North Carolina and South Carolina.

The Connecticut cases came about a month later. They are of concern in the Danbury area because some drug users from the city and its suburbs go to Bridgeport to buy heroin.

Dr. Charles Herrick,Danbury Hospital's medical director of outpatient programs and crisis intervention services, said he did not know of anyone in the region getting sick from the heroin-steroid mix.

"That's not to say it's not out there," Herrick said. "But I'm the director of crisis intervention at the hospital. If someone had come to the emergency room with that, I would have heard about it."

In the 26 cases on the East Coast, the patients went to the hospital complaining of rapidly beating hearts, chest pains, tremors, palpitations, nausea and shortness of breath. Tests revealed they had abnormally high blood sugar levels and abnormally low blood pressure.

Emergency room physicians learned all of the patients had used heroin. Their symptoms, however, were the opposite of the typical heroin overdose, which is marked by drugged-out euphoria and depressed breathing and central nervous system responses.

After obtaining samples of the heroin used by the patients, and doing urine samples, doctors found clenbuterol poisoning in eight of the cases. They concluded that all 26 people with similar symptoms ingested the heroin/steroid mix.

None of the patients died, although several spent a few days in intensive care units before their systems returned to normal.

Belson of the CDC said it's highly likely others became ill, but never sought medical help.

"Not everyone will go to the emergency room and tell the doctors, 'I'm using heroin,' " he said. "There's a fear of being caught. Also, there may be people whose symptoms weren't as severe. We think these cases were just the tip of the iceberg. We don't know how big the iceberg is."

The U.S. Justice Department's National Drug Intelligence Center in 2002 reported heroin is one of Connecticut's most serious drug problems, and one that is growing.

The drug moves into the state from New York City along Interstate 95, and much of the heroin used in the Danbury area comes from Bridgeport. Because heroin's price is dropping and its purity increasing, it has made its way into the suburbs, where teenagers inhale it rather than inject it.

Every drug user takes a chance because he or she has no idea what's mixed in with the heroin.

"It's not like drug dealers are licensed and have to pass quality assurance tests," said Sam Segal, addiction services director of the Connecticut Valley Hospital in Middletown. "They cut the drug with baby laxatives, with quinine."

The only legal use for clenbuterol in the United States is by veterinarians, who use it to treat respiratory ailments in horses.

However, it is widely sold illegally to athletes and body builders as a muscle enhancer and a weight-loss drug. A quick Internet search shows many online companies advertising it for sale.

Johnson-Arbor of the state Poison Control Center said clenbuterol is an odd choice to mix with heroin.

Generally, she said, drug dealers choose some cheap, easily obtained white powder — even flour — to cut the heroin they sell. The more they dilute it, the more product there is to sell and the greater the profit.

Sometimes, she said, they add other drugs that enhance the heroin high. One of the eight users in Connecticut returned to the hospital with a heroin sample that contained heroin, clenbuterol and also procaine.

"Procaine is a local anesthetic that enhances the high," Johnson-Arbor said. "So that makes sense."

Johnson-Arbor said clenbuterol is not quite so easily obtained, and it's not cheap. Rather than enhancing a heroin high, it made users ill. "We really don't know why anyone would do this," she said.

Johnson-Arbor said the only good news in this mystery is there have been no other reports of the clenbuterol/heroin mix in the state since April.

"It may have passed," she said. "But that doesn't mean it might not come back. Or something else, next time."